title: Virtual arterial blood pressure feedback improves chest compression quality during simulated resuscitation.
abstract: BACKGROUND
  Quality chest compressions (CC) are the most important factor in successful cardiopulmonary resuscitation. Adjustment of CC based upon an invasive arterial blood pressure (ABP) display would be theoretically beneficial. Additionally, having one compressor present for longer than a 2-min cycle with an ABP display may allow for a learning process to further maximize CC. Accordingly, we tested the hypothesis that CC can be improved with a real-time display of invasively measured blood pressure and with an unchanged, physically fit compressor.
  
  
  METHODS
  A manikin was attached to an ABP display derived from a hemodynamic model responding to parameters of CC rate, depth, and compression-decompression ratio. The area under the blood pressure curve over time (AUC) was used for data analysis. Each participant (N=20) performed 4 CPR sessions: (1) No ABP display, exchange of compressor every 2 min; (2) ABP display, exchange of compressor every 2 min; (3) no ABP display, no exchange of the compressor; (4) ABP display, no exchange of the compressor. Data were analyzed by ANOVA. Significance was set at a p-value<0.05.
  
  
  RESULTS
  The average AUC for cycles without ABP display was 5201 mm Hgs (95% confidence interval (CI) of 4804-5597 mm Hgs), and for cycles with ABP display 6110 mm Hgs (95% CI of 5715-6507 mm Hgs) (p<0.0001). The average AUC increase with ABP display for each participant was 20.2±17.4% 95 CI (p<0.0001).
  
  
  CONCLUSIONS
  Our study confirms the hypothesis that a real-time display of simulated ABP during CPR that responds to participant performance improves achieved and sustained ABP. However, without any real-time visual feedback, even fit compressors demonstrated degradation of CC quality.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: riekeh@musc.edu.
authors.forename: Horst
authors.initials: H
authors.lastname: Rieke
authors.forename: Martin
authors.initials: M
authors.lastname: Rieke
authors.forename: Samkon K
authors.initials: SK
authors.lastname: Gado
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
authors.forename: Larry C
authors.initials: LC
authors.lastname: Field
authors.forename: Carlee A
authors.initials: CA
authors.lastname: Clark
authors.forename: Cory M
authors.initials: CM
authors.lastname: Furse
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McEvoy
mesh_terms: D019540:Area Under Curve; D001296:Audiovisual Aids; D001794:Blood Pressure; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D025461:Feedback, Physiological; D006439:Hemodynamics; D006801:Humans; D008348:Manikins; D011446:Prospective Studies
keywords: Arterial blood pressure; Cardiopulmonary resuscitation; Chest compressions; Simulation